10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER)
Randomized controlled trial published in Circulation. Cardiovascular interventions (2025)
Abstract
BACKGROUND: Primary percutaneous coronary intervention (PCI) with stenting is recommended in ST-segment-elevation myocardial infarction. Immediate stenting may cause distal embolization, microvascular damage, and flow disturbances, leading to adverse outcomes. We report the 10-year clinical outcomes of deferred stenting versus conventional PCI in patients with ST-segment-elevation myocardial infarction. METHODS: We conducted a 10-year follow-up study of the open-label, randomized DANAMI-3-DEFER trial (Third Danish Study of Optimal Acute Treatment of Patients With STEMI - Deferred Stent Implantation Versus Conventional Treatment), conducted in 4 PCI centers in Denmark. Patients with ST-segment-elevation myocardial infarction and acute chest pain <12 hours were randomized to deferred stenting >24 hours after the index procedure or conventional PCI with immediate stenting. In the deferred group, immediate stable Thrombolysis in Myocardial Infarction flow II to III was established, and intravenous administration of either a glycoprotein IIb/IIIa antagonist or bivalirudin for >4 hours after the index procedure was recommended. The primary outcome was a composite of hospitalization for heart failure or all-cause mortality. Key secondary outcomes included individual components of the primary outcome and target vessel revascularization. RESULTS: Of 1215 patients, 603 were randomized to deferred stenting and 612 to conventional PCI. After 10 years, deferred stenting did not significantly reduce the primary composite outcome (hazard ratio, 0.82 [95% CI, 0.67-1.02]; P=0.08). In the deferred group, 124 (24%) died versus 150 (25%) in the conventional PCI group (hazard ratio, 0.95 [95% CI, 0.75-1.19]). Hospitalization for heart failure was lower in patients treated with deferred stenting compared with conventional PCI (odds ratio, 0.58 [95% CI, 0.39-0.88]). Target vessel revascularization was similar in both groups (odds ratio, 1.20 [95% CI, 0.81-1.79]). CONCLUSIONS: Deferred stenting did not reduce all-cause mortality or the composite primary outcome after 10 years but reduced hospitalization for heart failure compared with conventional PCI. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Primary percutaneous coronary intervention (PCI) with stenting is recommended in ST-segment-elevation myocardial infarction.
Warum dies für die Hirudotherapie relevant ist
This 10-year follow-up of the randomized DANAMI-3-DEFER trial compared deferred stenting versus conventional immediate PCI in 1,215 STEMI patients, finding no significant reduction in all-cause mortality or the composite primary outcome (hospitalization for heart failure or all-cause mortality), though deferred stenting reduced heart failure hospitalizations. This article has no direct relevance to hirudotherapy, leech therapy, or the leech secretome — it is entirely focused on coronary intervention timing and makes no reference to leeches or leech-derived agents. The abstract mentions microvascular damage and flow disturbances as complications of immediate stenting, but provides no data connecting these mechanisms to any leech-related therapeutic context. Relevance to ASH's domain is absent based on the abstract alone.
Zitation
10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER)
Marquard JM et al. · Circulation. Cardiovascular interventions, 2025
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